Generated On: 10/14/2010 9:15:14 PM

Date Posted
DR-3: Notice of Dissolution 10/14/2010 DR-3
ID: 18005 Comm. # 18005

Name: Beltman for Supervisor Filed 10/14/2010

Type: County Candidate - Supervisor Audited

Status: Filed Certified

Committee Name Beltman for Supervisor

Address 5881 180th St.

City, State, Zip Sibley, IA 51249

Phone 712-758-3788

Effective Date of Dissolution................................................................................. 10/14/2010

Mary Beltman 10/14/2010

Signature of Treasurer Date Signed

THIS BOX APPLIES TO CANDIDATE COMMITTEES ONLY:

I, the candidate, certify that my candidate committee's cash balance is zero, all debts, obligations and loans have
been paid or satisfied in accordance with law as shown on my committee's final report and all campaign property
and leftover funds have been distributed in accordance with my committee's last filed Statement of Organization.

Darwin Beltman 10/14/2010

Signature of Candidate Date Signed

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD | 510 EAST 12th, SUITE 1A | DES MOINES, IA 50319 | (515) 281-4028 1 of 1